体质指数对移植肾功能恢复的影响

目的 探讨体质指数(body mass index,BMI)对肾移植术后移植肾功能恢复的影响.方法 回顾性分析2009年5月至2015年3月在昆明医科大学第一附属医院器官移植中心行活体供肾移植术的104例受者的临床资料,根据《中国成人超重和肥胖症预防控制指南》推荐的标准,将所有符合要求的受者分为消瘦组(BMI＜ 18.5 kg/m2)、正常组(BMI 18.5～23.9 kg,/n2)、肥胖和超重组(BMI＞ 23.9 kg/m2),比较3组移植肾术后1周、2周、3周、1个月、3个月、6个月及1年血肌酐(Cr)变化、移植肾功能延迟恢复(delayed graft function,DGF)、1年内急性排斥反应(acute rejection,AR)发生率.结果 消瘦组与正常组DGF和AR发生率差异无统计学意义(P＞0.05);肥胖和超重组DGF及AR发生率较正常组明显增高,差异有统计学意义(P＜0.05).消瘦组、正常组、肥胖和超重组移植肾术后1周、2周、3周、1个月、3个月、6个月及1年Cr变化均与BMI呈正比例关系,体型肥胖的受者Cr较体型瘦弱或正常者高,肾功能恢复慢.结论 BMI是DGF、AR的独立影响因素,肥胖和超重的受者术后发生DGF和AR风险高,Cr达到正常范围所需时间长,移植肾功能恢复慢.

Effect of body mass index on the recovery of graft function

Objective To investigate the effect of body mass index (BMI) on the recovery of renal function after renal transplantation.Methods Retrospective analysis of the clinical data of 104 recipients who received living donor kidney transplantation in the First Affiliated Hospital of Kunming Medical University from May 2009 to March 2015.According to the recommend standards of guidelines for the prevention and control of overweight and obesity in China,all recipients were divided into 3 groups,the lean group (BMI ＜18.5 kg/m2),normal group (BMI 18.5 ～ 23.9 kg/m2),and obesity and overweight group (BMI ＞ 23.9 kg/m2).Renal transplantation operation in the 3 groups were compared after 1 week,2 weeks,3 weeks,1 month,3 months,6 months and 1 year of serum creatinine (Cr),and delayed graft function recovery (DGF),acute rejection (AR) incidence.Results There was no significant difference in the incidence of DGF and AR between the group and the normal group (P ＞ 0.05).The incidence of obesity and overweight group AR and DGF were significantly higher than the normal group (P ＜ 0.05).The changes of serum Cr of three groups in 1 week,2 weeks,3 weeks,1 month,3 months,6 months and 1 year after renal transplantation were positively proportional to BMI.The serum creatinine of obese patients was higher than that of thin or normal persons,and the renal function recovered slowly.Conclusions BMI is an independent influence factor of DGF and AR,and the risk of DGF and AR is high in obese and overweight patients.Cr reached the normal range for a long time,and the recovery of renal function was slowly.